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How Many Years Can You Take Cialis?

Kelly Brown MD, MBA

Reviewed by Kelly Brown, MD

Written by Geoffrey Whittaker

Published 02/14/2023

Updated 03/06/2024

Cialis is one of the most effective treatments for erectile dysfunction on the market today — but what about tomorrow, next month and two decades from now? Just how effective and safe is Cialis over the long term?

It’s a question some people with erectile dysfunction, or ED, forget to ask. After all, Cialis has been proven safe and effective in a number of studies, and it’s FDA-approved for the treatment of ED.

But while there are extensive studies showing Cialis is safe for a couple of years, research hasn’t been done on the question of decades of usage.

We’re not sounding any alarms here — if you’re dealing with erectile dysfunction, Cialis and its generic version tadalafil, should offer a long-term or even permanent solution for what ails you and your member. But you should still be aware of the potential risks (and unanswered questions) before beginning a life-long regimen of medication.

Some men, after all, want sexual activity as frequently as possible (which is one of the reasons Cialis’s potential for daily use draws so much attention). But we want our ED treatments to work, too — even if we have other health problems.

Below, we’ve shared what we know about long-term Cialis safety, Cialis long-term side effects and some tips for how to use Cialis safely for many years to come.

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Is Cialis safe? Yes. Is Cialis safe over decades? We’re not sure.

Cialis is not a medication intended for temporary use. Most men do not see erectile dysfunction spontaneously disappear, and unless something drastically changes in your life, medications like Cialis are intended to work in an ongoing capacity. How long “ongoing” is, however, is somewhat of an unanswered question.

Here’s the good news: there are currently no reports of Cialis eventually ceasing to be an effective treatment. Likewise, there are no current studies suggesting that long-term use of Cialis is dangerous.

Assuming that you’re not taking nitrates, alpha-blockers or other medications for high blood pressure, hypertension or benign prostatic hyperplasia (BPH), we don’t know of any serious problems that you might see (more later on why these other medications can cause problems).

Some people might also wonder whether Cialis could lose effectiveness over time. While some users might argue that they need to increase their dosage, generally speaking, there’s no research to suggest that men can build immunity or tolerance to these medications.

So if you’re wondering whether Cialis has a cut-off point for safe use, the answer is no… so far.

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Here’s the problem: we don’t have a lot of data about the long-term risks and complications associated with regular use of tadalafil. Currently, there are no known long-term side effects of taking Cialis, but that can honestly be attributed to a lack of knowledge more than a lack of side effects.

A 2017 paper in the journal Urologia Internationalis acknowledged that while there were substantial studies done on short-term effects, there was a lack of long-term and follow-up testing, and that the efficacy and safety long-term “could not be evaluated.”

Most of the study data available today doesn’t look at the multi-decade use of Cialis — in fact, few reach more than a few years into the future.

A 2004 clinical trial published in the Journal of European Urology found no serious adverse effects from long-term use of tadalafil in more than 1,000 men using various dosages. The problem is that those results only take into account 24 months of use. Most men will likely plan to take Cialis for more than two years — or at least hope to.

You probably already know this, but Cialis cannot cure erectile dysfunction. Cialis is an ongoing treatment for the symptoms of chronic sexual dysfunction. It’s a prescription phosphodiesterase type 5 (PDE5) inhibitor — one of the two most popular on the market, alongside Viagra.

Erections are the product of two processes: blood flow to the penis’s blood vessels, and the trapping of that blood in two long chambers called the corpora cavernosa. When you become aroused, your brain sends chemical signals to your body to dilate the blood vessels in the penis, allowing blood to flow in before a muscle closes things up like a filled balloon.

ED is what happens when those processes break down — and it’s a common problem. The National Institutes of Health say that an estimated 30 million to 50 million men nationwide have some degree of erectile dysfunction.

ED can be caused by many factors, including poor diet, obesity, blood flow issues, stress, anxiety, illicit or prescribed drugs, habits and hormones.

Luckily, PDE5 inhibitors work to sustain the dilation of your member’s blood vessels in the soft tissue of your penis, which gives you (and helps you maintain) firmer erections.

But these medications must be taken regularly — daily in some cases — for those effects to continue.

Unlike most other PDE5 inhibitors, tadalafil can be taken either as-needed or once per day. And, according to the National Library of Medicine, a single dose has been shown to be effective for up to 36 hours.

So is it a cure? No. But it can be an effective (and potentially long-term) solution, as long as it’s used correctly.

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Let’s not mince words, guys. The razor you shave your face with is literally called a safety razor, and yet you probably know all too well about the serious side effects of misusing even a safety blade. It doesn’t take medical advice to know that razors can cut.

Cialis has a lot of research backing it as one of the most safe and effective treatment options for erectile dysfunction, but that doesn’t mean you just start popping pills when you’re ready to get into bed with someone.

First of all, since tadalafil is a prescription medication, you’ll need to talk to a healthcare professional. They’ll help you better understand your individual ED circumstances, address potential causes like obesity, stress and hormones and suggest (and potentially prescribe) treatment.

Dosage is an important element of effective Cialis use. According to FDA.gov, daily doses of Cialis are typically smaller than as-needed doses. While as-needed doses will range from 10mg to 20mg, a daily dose will typically range between 2.5mg and 5mg.

Those lower doses are effective when taken daily, and a larger daily Cialis dose would offer no additional benefits — just added risks.

There are a few things you should know about what’s up (or isn’t) down there:

  • Avoid dangerous drug interactions. Cialis should not be taken alongside other ED medications — particularly other PDE5 inhibitors — without a healthcare professional’s oversight. Before taking Cialis, you should also tell your provider if you take any heart or blood pressure medications or other drugs with the potential to interact with your blood pressure, or you have a history of heart disease. You’ll also need to avoid grapefruit. Learn more about tadalafil interactions from our blog.

  • Be wary of side effects. Cialis can cause side effects. Common side effects from Cialis are headache, indigestion, back pain, muscle pain, flushing and nasal congestion. A small number of patients also reported vision loss in some circumstances.

  • Rare Cialis side effects are also possible. They include sudden hearing loss, renal impairment and prolonged erection (priapism) — those four-hour erections you’ve likely heard about. According to the FDA priapism can cause permanent damage to erectile tissue if not treated as soon as possible.

  • Use Cialis as prescribed. Misuse of the medication may increase the risk of certain Cialis® (tadalafil) side effects over time, so don’t make executive decisions about how many pills you take. Instead, consult a healthcare provider about dosage changes if Cialis doesn't work. Overdosing on Cialis or taking it alongside other ED medications can cause sudden and severe blood pressure drops, which can result in chest pain or low blood pressure leading to death.

  • Consider the mental health side of ED. While you may have physical reasons behind ED, the cause of your ED might also be psychological. Remember that insecurity, fear of intimacy, low self-esteem and conditions like anxiety and depression can play a role in performance issues.

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The science of Cialis use is still very much evolving on the long-term effects of regular doses. We’d like to tell a 20-year-old experiencing ED for the first time that he can depend on tadalafil for the rest of his life, but the truth is that we just won’t know until more research is done.

In the meantime, however, we can tell men in their 20s, 30s, 40s, 50s and beyond that if they’re concerned with long-term risks or problems with the active ingredient tadalafil, they should consider the following tips: 

  • Try other meds. Other erectile dysfunction treatments might work better for your individual needs, so if you’re not seeing the results you want from tadalafil, consider sildenafil (generic for Viagra), Stendra (avanafil), Levitra or check out our chewable ED meds hard mints for alternative ways of treating ED.

  • Consider your mental health. If you think that you might be dealing with psychological ED, consult a psychiatrist or mental health professional to see if other treatments might be helpful, instead of or in addition to medications.

  • Examine your diet, sleep, drinking and exercise habits. There may also be lifestyle factors that a healthcare provider will want you to address, like diet, stress or weight.

  • Mind your dosage. Though tadalafil has been proven safe, there are still important cautions to consider before starting a Cialis regimen. Check out our Cialis dosage guide for more on how to safely get the maximum effect from Cialis.

If you’re not ready to take the next step in treatment of erectile dysfunction, or you’re just learning about ED, we have resources available to help you learn more about the causes, symptoms and treatments of this condition, and eventually determine if Cialis is right for you.

5 Sources

  1. Zhufeng Peng, Lu Yang, Qiang Dong, Qiang Wei, Liangren Liu, Bo Yang; Efficacy and Safety of Tadalafil Once-a-Day versus Tadalafil On-Demand in Patients with Erectile Dysfunction: A Systematic Review and Meta-Analyses. Urol Int 18 October 2017; 99 (3): 343–352. https://karger.com/uin/article/99/3/343/323239/Efficacy-and-Safety-of-Tadalafil-Once-a-Day-versus.
  2. Reference ID: 3024692 - food and drug administration. (n.d.-e). https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/021368s20s21lbl.pdf.
  3. Sooriyamoorthy T, Leslie SW. Erectile Dysfunction. [Updated 2023 May 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562253/.
  4. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Phosphodiesterase Type 5 (PDE5) Inhibitors. [Updated 2017 Aug 2]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548192/.
  5. Montorsi, F., Verheyden, B., Meuleman, E., Jünemann, K. P., Moncada, I., Valiquette, L., Casabé, A., Pacheco, C., Denne, J., Knight, J., Segal, S., & Watkins, V. S. (2004). Long-term safety and tolerability of tadalafil in the treatment of erectile dysfunction. European urology, 45(3), 339–345. https://pubmed.ncbi.nlm.nih.gov/15036680/.
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Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Kelly Brown MD, MBA
Kelly Brown, MD

Dr. Kelly Brown is a board certified Urologist and fellowship trained in Andrology. She is an accomplished men’s health expert with a robust background in healthcare innovation, clinical medicine, and academic research. Dr. Brown is a founding member of Posterity Health where she is Medical Director and leads strategy and design of their Digital Health Platform, an innovative education and telehealth model for delivering expert male fertility care.

She completed her undergraduate studies at University of North Carolina at Chapel Hill (go Heels!) with a Bachelor of Science in Radiologic Science and a Minor in Chemistry. She took a position at University of California Los Angeles as a radiologic technologist in the department of Interventional Cardiology, further solidifying her passion for medicine. She also pursued the unique opportunity to lead departmental design and operational development at the Ronald Reagan UCLA Medical Center, sparking her passion for the business of healthcare.

Dr. Brown then went on to obtain her doctorate in medicine from the prestigious Northwestern University - Feinberg School of Medicine and Masters in Business Administration from Northwestern University - Kellogg School of Management, with a concentration in Healthcare Management. During her surgical residency in Urology at University of California San Francisco, she utilized her research year to focus on innovations in telemedicine and then served as chief resident with significant contributions to clinical quality improvement. Dr. Brown then completed her Andrology Fellowship at Medical College of Wisconsin, furthering her expertise in male fertility, microsurgery, and sexual function.

Her dedication to caring for patients with compassion, understanding, as well as a unique ability to make guys instantly comfortable discussing anything from sex to sperm makes her a renowned clinician. In addition, her passion for innovation in healthcare combined with her business acumen makes her a formidable leader in the field of men’s health.

Dr. Brown is an avid adventurer; summiting Mount Kilimanjaro in Tanzania (twice!) and hiking the incredible Torres del Paine Trek in Patagonia, Chile. She deeply appreciates new challenges and diverse cultures on her travels. She lives in Denver with her husband, two children, and beloved Bernese Mountain Dog. You can find Dr. Brown on LinkedIn for more information.

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